Administration of empiric antimicrobial therapy is standard practice in the management of neutropenic fever, but there remains considerable debate about the selection of an optimal regimen. In view of emerging evidence regarding efficacy and toxicity differences between empiric treatment regimens, and strong evidence of heterogeneity in clinical practice, the current guidelines were developed to provide Australian clinicians with comprehensive guidance for selecting an appropriate empiric strategy in the setting of neutropenic fever. Beta-lactam monotherapy is presented as the treatment of choice for all clinically stable patients while early treatment with combination antibiotic therapy is considered for patients at higher risk. Due consideration is given to the appropriate use of glycopeptides in this setting. Several clinical caveats, accounting for institution-and patient-specific risk factors, are provided to help guide the judicious use of the agents described. Detailed recommendations are also provided regarding time to first dose, timing of blood cultures, selection of a first-line antibiotic regimen, subsequent modification of antibiotic choice and cessation of therapy.
Influenza A virus (IAV) is economically important in pig production and has broad public health implications. In Europe, active IAV surveillance includes demonstration of antigen in nasal swabs and/or demonstration of antibodies in serum (SER) samples; however, collecting appropriate numbers of individual pig samples can be costly and labour‐intensive. The objective of this study was to compare the probability of detecting IAV antibody positive populations using SER versus oral fluid (OF) samples. Paired pen samples, one OF and 5–14 SER samples, were collected cross‐sectional or longitudinally. A commercial nucleoprotein (NP)‐based blocking ELISA was used to test 244 OF and 1004 SER samples from 123 pens each containing 20–540 pigs located in 27 UK herds. Overall, the IAV antibody detection rate was higher in SER samples compared to OFs under the study conditions. Pig age had a significant effect on the probability of detecting positive pens. For 3–9‐week‐old pigs the probability of detecting IAV antibody positive samples in a pen with 95% confidence intervals was 40% (23–60) for OF and 61% (0.37–0.80) for SER (P = 0.04), for 10–14‐week‐old pigs it was 19% (8–40) for OF and 93% (0.71–0.99) for SER (P < 0.01), and for 18–20‐week‐old pigs it was 67% (41–85) for OF and 81% (0.63–0.91) for SER (P = 0.05). Collecting more than one OF sample in pens with more than 25 less than 18‐week‐old pigs should be further investigated in the future to elucidate the suitability of OF for IAV surveillance in herds with large pen sizes.
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